Drugs Affecting GI Secretions Flashcards
What are the underlying causes of GI Disorders?
Dietary Excess
Stress
Hiatal Hernia ( upper part of the stomach bulges through the diaphragm into the chest cavity)
Esophagea Reflux
Adverse Drug Effects
Underlying Diseases/Disorders
Peptic Ulcer Disease
What does drugs acting on GI Secretions do?
Decrease GI secretory activity
Block the action of GI secretions
Form protective coverings on the GI lining to prevent erosion from GI secretions
Replace missing GI enzymes that the GI tract or ancillary glands and organs can no longer produce
Every drug works differently!
What is Peptic ulcer Disease?
Erosions in the lining of the stomach or adjacent areas of the GI tract.
What are the symptoms of Peptic Ulcer Disease?
Gnawing, burning pain, often occurring after meals - worse when laying down
What are the cause of Peptic Ulcer Disease?
- NSAID use for example ibuprofen. This is because NSAIDS reduce prostaglandin secretion and prostaglandin protect the gastric mucosae. Without this protection the stomach cannot protect the mucosa from gastric acid.
- Bacterial infection by Helicobacter pylori bacteria
- Stress: physical and psychological
What are important things to remember when giving drugs that affect GI secretions in children?
Children may use antacids, H2 Antagonist’s & PPI’s (protein pump inhibitors)
Concerns for this age group would be electrolyte imbalances and interference with nutrition (from side effects).
What are important things to remember when giving drugs that affect GI secretions in adults?
Some concerns would be:
* Overuse (OTC)
* GI discomfort continuing (Continued OTC use without following up with provider to assess for underlying causes)
* Electrolyte disturbance
* Interference with other drugs
There are many issues that may arise from long-term use - over a year can result to C-diff & bone loss.
The drugs have not been cleared safe for pregnancy/lactation and may enter into breastmilk
- Misoprostol - will result in miscarriage (cat.x) - Abortifacient
What are important things to remember when giving drugs that affect GI secretions in older adults?
There may be long term effects when these drug are prescribed frequently
We should prescribe these with caution for patients with renal/hepatic impairments - slower metabolism and excretion.
Many OTC drugs contain the same agents and may also interfere with RX medication (ensure accidental OD does not occur)
What are the suffix(ex) and potential outlier for Histamine-2 (H2) Antagonists?
“tidine”
Cimetidine
Famotidine (most common)
Nizatidine
What are Histamine-2 (H2) Antagonists prescribed for?
Treatment of ulcers
Prevention of ulcers related to:
* Stress
* Long-term NSAID use
Treatment of GERD
Treatment of pathological hypersecretory conditions such as
Zollinger–Ellison syndrome (stomach is producing excess amounts of secretions)
Relief of symptoms of heartburn, acid indigestion, and sour
stomach (OTC preparations)
How does Cimetidine work?
Cimetidine is a Histamine-2 (H2) Antagonist which selectively block H2 receptor sites which reduces gastric acid secretion and pepsin production leading to decreasing levels of these.
It also and blocks release of hydrochloric acid
Which patients should we be cautious of prescribing Famotidine to?
Famotidine is a Histamine-2 (H2) Antagonist.
We should be cautious when giving this to patients with cardiac/renal/hepatic dysfunction.
What adverse effects are associated with Nizatidine use?
Nizatidine is a Histamine-2 (H2) Antagonist and can cause adverse reactions related to:
GI effect : diarrhea or constipation
CNS effect: headache, dizziness, sometimes hallucinations, somnolence/confusion.
Cardiac arrythmias and hypotension because there are H2 receptors on the heart.
What drug interactions do we need to be aware of when giving a patient Histamine-2 (H2) Antagonists?
There are too many to mention but for all of them there is an increased risk of slower metabolism of the other medication (not the H2 antagonists) which may lead to toxicity.
What are important things to assess for before giving a patient Cimetidine?
Cimetidine is a H2 antagonist.
History:
Check for pregnancy/lactation
Impaired renal/hepatic function
Physical:
Neurological status incl. orientation & affect for adverse CNS reactions
Cardiopulmonary status incl. pulse and BP
Abdominal assessment
What nursing conclusions can be made prior to giving a patient Cimetidine?
Impaired comfort - r/t CNS and GI effect
Altered Sensory Perception (kinesthetic/auditory) r/t CNS effect
Injury risk - r/t CNS effect
Altered tissue perfusion risk - risk for hypotension r/t cardiac arrythmias.
Knowledge deficit.
What implementations should be done when giving a patient Nizatidine?
Nizatidine is a H2 Antagonist.
Oral drug should be admin. ac or with meals or at bedtime - because that is when the patient is most likely to have symptoms.
Monitor patient closely with IV admin. because this is when the patient is most at risk for cardiac arrythmias.
Monitor for potential drug-drug interactions
Comfort & Safety: easy access to bathroom in case of diarrhea & assistance with ambulation due to CNS effect.
Teaching patient not to do dangerous activities until the know response to the drug (driving, heavy machinery)
What are the suffix(ex) and potential outlier for Antacids?
Carbonates : Sodium Bicarbonate & Calcium carbonate
Salts: Magnesium Salts & Aluminum Salts
What are Antacids used for?
Used when a patient have to much acid which may cause stomach upset or conditions that cause excess acid such as peptic ulcers, gastritis or hiatal hernias - a hernia that is pressing up on the stomach.
How does Antacids work?
They are a group of is an inorganic chemicals that work by neutralizing stomach acid by a direct chemical reaction.
What conditions should we be cautious of before giving a patient Antacids?
Any condition that can be exacerbated by electrolyte imbalance.
GI obstruction - would increase adverse effects.
What are some adverse reactions that may happen when a patient are taking Antacids?
Adverse reactions are related to the acid/base imbalance issues.
We may see adverse reactions such as rebound acidity - which happens when stomach becomes alkaline from taking antacid so it produces more acid.
Alkalosis - from neutralizing effect.
Constipation or Diarrhea
Calcium Bicarbonate in particular may cause Hypercalcemia and Hypophosphatemia - because calcium and phosphate have an inverse relationship.
What are some drug-drug interactions that we should keep an eye out for when a patient is taking Antacids?
It may have an effect on the absorption of many other drugs.
Should be taken 1 hr before or 2 hrs after other drugs because antacids effect absorption of other drugs due to altered chemical composition of the stomach.
What assessments should we do before giving a patient Aluminum salts?
Aluminum salts are antacids and we should be assessing for Pregnancy/lactation.
Renal dysfunction - due to possible electrolyte imbalance of the drugs which may effect the kidneys.
Do a baseline physical abdominal assessment.
Labs:
Renal function
Electrolytes
What nursing conclusions’ can we expect with patients taking Antacids?
Altered GI motility related to adverse effects.
Electrolyte imbalance risks
Knowledge deficit
What implementations should be expect to make when and after giving a patient Sodium Bicarbonate?
Sodium bicarbonate is an antacid and we should expects implementations such as:
Giving other oral meds. 1 hr. prior or 2 hrs. after admin of antacid.
Chew tablets properly and drink water after.
Monitoring serum electrolytes
Asses for signs/symptoms of electrolyte imbalance and acid/base imbalance
Monitor for diarrhea/constipation- implement bowel program if needed
Monitor nutrition w/severe diarrhea or constipation result in poor food intake.
Educate for risk of acid rebound.
What are the suffix(ex) and potential outlier for Proton Pump Inhibitors (PPI’s)?
“Prazole”
Omeprazole (OTC)
Esomeprazole (OTC)
Lansoprazole (OTC)
Pantoprazole
Rabeprazole
What is Rabeprazole prescribed for?
Rabeprazole is a PPI and is given for treatment/prevention of ulcers
Treatment of GERD
Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome
How does Pantoprazole work?
Pantoprazole is a PPI and these drugs suppress the secretion of hydrochloric acid into the lumen of the stomach by acting at specific secretory surface receptors to prevent the final step of acid production which decreases overall level of stomach acid.
What are some adverse effects to look out for when giving a patient Omeprazole?
Omeprazole is a PPI and we should be aware of potential side effects such as
CNS effect: dizziness & headache
GI effect: Diarrhea, abdominal pain and nausea.
With PPIs, what drug-drug interactions should we teach a patient about and monitor for?
Benzodiazepines & phenytoin (medication for seizures) due to risk of increased toxicity.
Antiretroviral medications due to altered levels of these - might end up not being effective or toxic effect.
Anticoagulants can increase toxicity of some of these and decrease effect of others.
What assessments should we do prior to giving a patient Lansoprazole?
Lansoprazole is a PPI and we should assess for Pregnancy/lactation
Physical:
neurological exam & abdominal assessment.
What conclusions could we make when a patient will be taking PPI’s?
The may have altered GI motility r/t GI effect
Imbalanced nutrition risk - can alter absorption of nutrients.
Altered sensory perception (Kinesthetic and auditory) - Related to CNS effect
Injury risk
Knowledge deficit
What implementations should we perform/teach patients when they are taking Esomeprazole?
Esomeprazole is a PPI.
Patients should not open, chew or crush capsules - should be swallowed whole to ensure therapeutic effectiveness.
Monitor for diarrhea - bowel program if needed
Monitor nutritional status - If GI effect is a problem. small frequent meals.
Safety/comfort measures -CNS effect
Follow up after 8 weeks if no improvement. Could be underlying conditions.
Patient education
What is the drug that we need to remember for the drug category GI Protectants?
Sucralfate
Why would we give Sucralfate to a patient?
To promote ulcer healing
How does Sucralfate work?
Coats the injured area of the stomach which prevents further injury from the acids, pepsins and bile salts.
It also promotes ulcer healing.
What patient condition would contraindicate giving a patient Sucralfate?
If the patient has renal failure because Sucralfate contains aluminum and therefore there is a risk of buildup of aluminum which may lead to aluminum toxicity.
What is an adverse reaction to Sucralfate?
Adverse effect are rare.
Constipation most likely.
Sucralfate is a GI protectant.
What are some drug-drug interactions that we and the patient should be aware of when administering Sucralfate?
Aluminum salts due to increased risk of aluminum toxicity.
Medications administered at the same
time because sucralfate is binding agent and could potential bind to the other drugs and prevent absorption.